Article

Changes in cancer mortality among HIV-infected patients: the Mortalité 2005 Survey.

Institut National de la Santé et de la Recherche Médicale (Inserm), U593, Bordeaux, France.
Clinical Infectious Diseases (Impact Factor: 9.37). 04/2009; 48(5):633-9. DOI: 10.1086/596766
Source: PubMed

ABSTRACT The goal of the current study was to describe the distribution and characteristics of malignancy related deaths among human immunodeficiency virus (HIV)-infected patients with use of data obtained from a national survey conducted in France in 2005 and to compare with results obtained from a similar survey conducted in 2000.
The underlying cause of death was documented using a standardized questionnaire fulfilled in French hospital wards and networks that were involved in the treatment of HIV-infected patients.
Among the 1042 deaths reported in 2005 (964 were reported in 2000), 344 were cancer related (34%), which represented a significant increase from 2000 (29% of deaths were cancer related) (P=.02); 134 of the cancer-related deaths were AIDS related and 210 were not AIDS related. Among the cancer-related causes of death, the proportion of hepatitis-related cancers (6% in 2000 vs. 11% in 2005) and non-AIDS/hepatitis-related cancers (38% in 2000 vs 50% in 2005) significantly increased from 2000 to 2005 (P=.03 and P=.01, respectively), compared with the proportion of cancer that was AIDS related and adjusting for age and sex. Among cases involving AIDS, the proportion of non-Hodgkin lymphoma-associated deaths did not change statistically significantly between 2000 and 2005 (11% and 10% of deaths, respectively).
In this study, an increasing proportion of lethal non-AIDS-related cancers was demonstrated from 2000 to 2005; meanwhile, the proportion of lethal AIDS-related cancers remained stable among HIV-infected patients. Thus, cancer prophylaxis, early diagnosis, and improved management should be included in the routine long-term follow-up of HIV-infected patients.

0 Bookmarks
 · 
86 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: At 30 years into the HIV infection epidemic, the optimal antiretroviral (ARV) regimen for infected patients with cancer remains unknown. We therefore sought to retrospectively study different ARV regimens used in this population. Data from HIV-infected patients seen at The University of Texas MD Anderson Cancer Center in Houston, Texas, USA from 2001 to 2012 were reviewed. Patients received nucleoside reverse transcriptase inhibitors (NRTIs) plus protease inhibitors (PIs), non-NRTIs (NNRTIs), integrase strand-transfer inhibitors (INSTIs), or combinations of them. A total of 154 patients were studied. Most patients were male (80%), white (51%) and had hematologic malignancies (HM) (58%). NRTIs were combined with PIs (37%), NNRTIs (32%), INSTIs (19%), or combinations (11%). INSTIs were the most commonly used in patients with HM and in those receiving high-dose steroids, or topoisomerase inhibitors (p<0.05). Side effects occurred in 35%, 14%, 3%, and 6% of patients receiving PIs, NNRTIs, INSTIs, and combinations, respectively (p 0.001). Grade 3-4 adverse events were uncommon. Multivariate logistic regression analysis demonstrated that INSTIs and NNRTIs were 9 times (95% confidence interval [CI], 1.4 to 50.8) and 11 times (95% CI, 1.9 to 64.7) more likely to be effective at 6 months, respectively, than PIs. This is the largest reported analysis studying different ARV regimens in HIV-infected cancer patients. Combinations that included PIs were the least favorable. NNRTIs and INSTIs had comparable efficacy, but INSTIs appeared to be the better tolerated ARVs on patients with HM or those receiving various chemotherapeutic agents. This article is protected by copyright. All rights reserved.
    Clinical Microbiology and Infection 02/2014; · 4.58 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: In high-income settings, the spectrum of morbidity and mortality experienced by Human Immunodeficiency Virus (HIV)-infected individuals receiving combination antiretroviral therapy (cART) has switched from predominantly AIDS-related to non-AIDS-related conditions. In the context of universal access to care, we evaluated whether that shift would apply in Brazil, a middle-income country with universal access to treatment, as compared to France.
    BMC Infectious Diseases 05/2014; 14(1):278. · 3.03 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The optimal antiretroviral therapy (ART) regimen for HIV-infected patients with cancer remains unknown as clinical trials are lacking and published data are insufficient to guide recommendations. When concomitant use of chemotherapy and ART is anticipated, overlap of toxic effects and drug-drug interactions between chemotherapy and ART may alter the optimal choice of ART. Prospective studies are urgently needed to further define the toxic effects of combined chemotherapy and ART in HIV-positive cancer patients. Such studies should aid the development of guidelines for treatment of this population. For now, clinicians should individualize decisions regarding treatment of HIV according to clinical and laboratory findings, cancer treatment plan (chemotherapy, radiotherapy, or surgery), liver or renal disease, potential adverse drug effects (e.g., rash, gastrointestinal intolerance, bone marrow suppression), and patient preference. This review focuses on what infectious diseases specialists need to know to select the most appropriate ART regimens for patients receiving chemotherapy.
    Clinical Infectious Diseases 03/2014; · 9.37 Impact Factor